NPI | 1912384017 |
---|---|
Entity Type | Organization |
Authorized Contact | VONNCEDRIC LEE DIXON Owener/Manager 844-864-7834 |
Organization Subpart ? | No |
Primary Taxonomy | 251S00000X Community/Behavioral Health (Licence: LA 14432993) |
Enumeration Date | 2015-04-28 |
Last Update Date | 2015-04-28 |